Postpartum Care

00:00
APGO educational topic number 13
00:02
postpartum care miss poly partum has
00:05
just delivered her baby 30 minutes ago
00:07
and her placenta 15 minutes ago in this
00:09
video we will review how Miss Pardons
00:11
body will transition to the non pregnant
00:13
state and how we can provide optimal
00:15
care for women during this time the
00:17
objectives of this video are to review
00:19
the normal maternal physiologic changes
00:21
of the postpartum period describe the
00:24
components of normal postpartum care
00:25
outline the topics to cover in
00:27
postpartum counseling and lastly provide
00:30
appropriate postpartum contraception
00:32
prior to her delivery poly Pardons
00:35
uterus weight approximately 1,000 grams
00:37
and had a volume of 5000 cc this is in
00:40
comparison to the non pregnant uterine
00:42
weight of 70 grams and a volume of 5 CCS
00:44
there are obviously many changes that
00:47
will occur to poly part of his body in
00:48
the postpartum period let’s review them
00:50
by system in the immediate postpartum
00:52
period the uterus contracts down and
00:54
returns to the pelvis by 2 weeks
00:56
postpartum and if it is normal-sized by
00:58
6 weeks postpartum lochia or the vaginal
01:01
discharge of the postpartum time goes
01:03
through three phases after delivery
01:05
initially it is menses like blood known
01:07
as lochia rubra and this may last for
01:09
the first few days after delivery the
01:11
second phase is lochia serosa a lighter
01:13
more watery discharge which will last
01:15
for a few weeks the last phase is lochia
01:18
alba a yellowish white discharge that
01:20
may persist for six to eight weeks these
01:22
are all normal and should be
01:23
distinguished from malodorous discharge
01:25
concerning for infection poly Pardons
01:27
vagina and vulva will likely be very
01:29
sore especially if she has had a
01:30
laceration with her vaginal delivery
01:32
most women will need some sort of
01:34
regular analgesia for the pain and
01:36
usually over-the-counter medications are
01:38
sufficient vaginal tone and pelvic floor
01:40
muscles gradually strengthen but they
01:42
may never return to the pre pregnancy
01:44
state pregnancy regardless of mode of
01:47
delivery is associated with incontinence
01:49
and pelvic organ prolapse Kegel or
01:51
pelvic floor exercises may help women
01:54
during this muscle recovery phase
01:56
Pauli’s cardiovascular system has been
01:58
revved up during pregnancy with cardiac
02:00
output increased by 30 to 50 percent and
02:02
circulating volume increased by about 30
02:05
percent approximately 1,000 CCS of
02:08
volume is lost during delivery there is
02:10
also a large fluid shift from the x
02:12
vascular to the intravascular space
02:14
leading to significant diuresis normal
02:16
cardiovascular function returns about
02:18
two to three weeks following delivery
02:20
moving on to the coagulation system the
02:23
human body has procoagulant and
02:25
anticoagulant pathways with the goal of
02:27
a balance between the risks of forming a
02:29
blood clot and the risks of bleeding
02:31
pregnancy is a hypercoagulable state
02:32
with an increase in procoagulant factors
02:35
this protects the body from excessive
02:37
bleeding at the time of delivery the
02:39
risk of venous Rambo leak event is
02:41
increased during pregnancy and is
02:42
especially increased in the postpartum
02:44
time the balance is restored at
02:46
approximately six to eight weeks
02:47
postpartum during pregnancy there is
02:50
increased blood flow to the kidneys this
02:52
leads to an increase in the glomerular
02:54
filtration rate or GFR also remember
02:57
that the creatinine of a pregnant woman
02:58
is usually around 0.8 the GFR will stay
03:02
elevated for two to three weeks after
03:04
delivery now let’s switch gears and talk
03:07
about how to best take care of poly
03:08
partum during her postpartum period here
03:11
you are
03:11
medical student extraordinaire ready to
03:13
take care of your postpartum patients
03:15
you remember that your attending doctor
03:17
dave Marzano had a handy trick for
03:19
remembering the important aspects of
03:20
postpartum care remember the seven B’s
03:23
of postpartum care breast versus bottle
03:26
determine her method of feeding and
03:28
encourage breastfeeding as much as
03:29
possible the American College of
03:32
Obstetricians I know colleges in the
03:33
American Academy of Pediatrics both
03:35
recommend exclusive breastfeeding for at
03:37
least six months
03:38
bladder ask about urinary retention and
03:41
incontinence some women may have slow
03:44
return of bladder functions secondary to
03:45
nerve compression during delivery or
03:47
from the anesthetic effects of regional
03:49
anesthesia all woman should urinate
03:51
within six hours of delivery or six
03:53
hours after catheter removal 25 percent
03:56
of women will also have stress urinary
03:57
incontinence during the immediate time
03:59
after a vaginal delivery number three
04:01
bowel has your patient had a bowel
04:03
movement woman taking opioid pain
04:05
medications or those with a third or
04:07
fourth degree laceration should be
04:08
offered a stool softener number four
04:10
bleeding ask about volume and presence
04:12
of clots review expectations about
04:14
length of bleeding and discharge number
04:16
five bottom ask about perineal pain or
04:19
irritation and examine the perineum if
04:20
there are any complaints ensure that
04:22
appropriate pain medications are
04:24
provided
04:25
that the postpartum blues are very
04:27
common in the immediate postpartum time
04:28
see if she has any risk factors for
04:30
developing postpartum depression such as
04:32
a history of depression or poor social
04:34
support discuss warning signs of
04:36
postpartum depression and lastly number
04:38
seven birth control it is important to
04:41
discuss this because approximately 15%
04:43
of non-nursing women are fertile at six
04:45
weeks and approximately 50% of women
04:48
will resume sexual intercourse prior to
04:50
their six-week follow-up visit if a
04:52
patient is breastfeeding she is
04:53
partially protected against pregnancy
04:54
however the breastfeeding must be
04:56
exclusive and every three hours and the
04:58
patient must be amenorrhea typically a
05:00
combination estrogen progesterone
05:02
contraception is avoided while
05:03
breastfeeding because of the fear that
05:05
it may hamper milk production however it
05:07
is considered safe for breastfeeding
05:08
once milk supply has been established
05:10
progesterone only forms of contraception
05:13
including the mini pillar Micra nor
05:14
Nexplanon or the progesterone IUD will
05:17
not affect milk supply if she is not
05:19
breastfeeding then she may be placed on
05:21
any contraception however combination
05:23
estrogen and progesterone she probably
05:25
started two to three weeks postpartum to
05:27
decrease the thromboembolic risk this
05:28
concludes the aapko video on postpartum
05:30
care we reviewed maternal physiological
05:33
changes the components and what to
05:34
discuss in postpartum counseling and
05:36
appropriate postpartum contraception